Psychiatric medications, science, marketing, psychiatry in general, and occasionally clinical psychology. Questioning the role of key opinion leaders and the use of "science" to promote commercial ends rather than the needs of people with mental health concerns.

Wednesday, June 04, 2008

Antipsychotics were the sixth best selling class of medications globally in 2007, according to IMS Health. They raked in a cool $20.7 billion, an increase of 10.7% from 2006. Thank God we are doing a better job of overrecognizing, er, appropriately treating bipolar disorder. Antidepressants were #7, at $19.7 billion, down nearly seven percent. This does not appear to be due to declining prescriptions. Blame generics, not decreased prescriptions for the lower numbers. With Cymbalta, Lilly has shown that new antidepressants don't have to be anything special, so it would behoove other companies to release other run of the mill antidepressants, attach a comical, er, highly educational marketing campaign such as Depression Hurts, then watch the money roll in. Just some free advice.

How about the top 10 drugs? Three of them were antipsychotics. No, I'm not kidding. Most surprisingly, Zyprexa had the best figures worldwide, which was interesting given the flat U.S. sales in 2007. Seroquel outsold Zyprexa in the U.S., but Zyprexa had a better run globally. Who knows what tricks are being used to sell Zyprexa internationally? Never mind, it's not like Lilly would do anything sly to market Zyprexa.

The new era of antipsychotics for everything appears to be in full swing.

2. Are you suggesting that the wide-ranging use of antipsychotics in children for hyperactivity, "bipolar," conduct disorder, and other bad behaviors is based on solid evidence? How about watered-down cases of bipolar disorder in adults? How about Alzheimer's, where the clinical trial data are quite weak for efficacy yet quite strong for ill effects like death?

If you wonder what I'm talking about, see the Florida report noting that kids on Medicaid who received medication -- their most common diagnosis was ADHD. Also see the Viva Zyprexa campaign that has been discussed here and, in more depth, at Furious Seasons. How about BMS settling a gigantic lawsuit with the Dept. of Justice for off-label marketing of Abilify? Also feel free to glance at the clinical trials of antipsychotics in the elderly; it's not an impressive picture.

What is my point, then? Use of treatments in accordance with reasonable evidence -- that makes sense to me. Widespread use of treatments where a favorable benefit-risk ratio is unestablished, not so much.

And as I've written about previously, I would indeed argue that disease mongering is firmly in place regarding bipolar disorder.

And don't forget the campaign to sell atypical antipsychotic drugs for adjunctive treatment of refractory depression! Charles Nemeroff and his cronies are pushing Risperdal and Abilify for this indication. Never mind about weight gain. Never mind about akathisia. Never mind about emergent suicidality. You won't find any frank discussion of those problems in their infomercials. Just talking up that the drugs beat placebo -- woo hoo!! -- but no comparison with existing treatments. Clin Psych has had several comments on these shills in recent months.

The use of antipsychotics for depression, anxiety, social anxiety, public speaking anxiety and most importantly, in children is out of control destruction of brains and bodies. These drugs were not intended for anything other than Schizophrenia, and then there are few, if any? long term use studies--oh wait--yes there are--they are not as efficacious as first thought, and they are being abused in nursing homes when in fact their is a black box warning for use in elderly.

I've witnessed firsthand distruction of mind and body in my daughter, these drugs cause cancer, the list goes on and on, anyone who uses them has a lifespan shortened, and to have them mainstreamed into "depression" etc is absurd, and a crime.

The general public has no idea these drugs are dangerous and one will walk out of a PCP office with Seroquel rx for sleep and think its nothing but a sleeping pill.Until they cannot wake up for 14 hours and then have a brain fog so bad they won't know what hit them.

"What does how much money antipsychotics generate in revenue have to do with their effectiveness, though?"

Well, since CATIE, among others have shown atypicals don't really seem to possess much (if any) advantage over older, much cheaper, antipsychotics, then their domination of the schizophrenia market is puzzling from a scientific viewpoint. I'm not saying I like some of the nasty side effects induced by older antipsychotics, but the newer drugs are coming with their own substantial set of problems.

And the evidence for atypical antipsychotics for kids for ADHD, "bipolar" and the rest just doesn't exist. So, we are seeing a lot of scripts written despite a lack of supporting evidence.

How much these drugs generate in revenue has little to do with their effectiveness -- isn't that a problem?

No surprise to see Seroquel in that U.S. top 10. That's one expensive drug and with its newfound ability to cure depression, it's got to be feeling pretty good out there in the field of atypicals. Ah, drowsing America one script at a time...

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About Me

I'm an academic with a respectable amount of clinical experience and no drug industry funding. Given my lack of time, don't expect multiple daily updates. Certain things about clinical psychology, the drug industry, psychiatry, and academics drive me nuts, and you'll probably pick up on these pet peeves before long...